Provider Demographics
NPI:1912332180
Name:CORONADO CONTINUING CARE CENTER LTD CO
Entity Type:Organization
Organization Name:CORONADO CONTINUING CARE CENTER LTD CO
Other - Org Name:CORONADO AT STONE OAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-954-4114
Mailing Address - Street 1:2537 GOLDEN BEAR DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2377
Mailing Address - Country:US
Mailing Address - Phone:214-954-4114
Mailing Address - Fax:214-871-3057
Practice Address - Street 1:19638 STONE OAK PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3279
Practice Address - Country:US
Practice Address - Phone:214-954-4114
Practice Address - Fax:214-871-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138286314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025524Medicaid
TX001025524Medicaid